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Goodall-Witcher Healthcare Employment Application

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We deeply appreciate your interest in Goodall-Witcher Healthcare! Thank you for taking the time to complete this application. If you would rather download a PDF version to fill out and mail in, please click the button below.

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Please contact the human resources department with any employment questions at

The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law also prohibits other types of discrimination such as age, citizenship, disability, veteran status, attainment of benefits, and participation in union activities. The laws of most states and localities also prohibit some or all of the above types of discrimination as well as some additional types including, but not limited to, discrimination based upon ancestry, marital status, parental status, sexual orientation, or source of income. The Fair Credit Reporting Act imposes restrictions with respect to information obtained from a consumer reporting agency, including, but not limited to, information regarding credit data, personal character, general reputation and mode of living. This list, however, is not exhaustive of the grounds on which discrimination is prohibited.

IMPORTANT INSTRUCTIONS: DO NOT use your browser’s back button while completing this form; use the FORM BUTTONS to navigate the different sections of the form.
All fields are required. If a question does not apply to you, enter N/A.

Personal Information

Are you legally eligible for employment in the U.S.A.?

If hired, you are required to submit proof of your eligibility to work in the U.S.A.

Are you over the age of 18?

If no, hire is subject to verification that you are of minimum legal age.

Have you ever pleaded “guilty” or “no contest” to, or been convicted of a crime?

Were you previously employed by us?